Etiologies and Delirium Rates of Elderly ED Patients with Acutely Altered Mental Status: A Multicenter Prospective Study

• Published in: The American journal of emergency medicine Vol. 35; no. 1; pp. 71 - 76
• Main Authors: Aslaner, Mehmet Ali, M.D, Boz, Mustafa, M.D, Çelik, Ali, M.D, Ahmedali, Asliddin, M.D, Eroğlu, Sercan, M.D, Aksu, Nalan Metin, M.D, Eroğlu, Serkan Emre, M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2017; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Chronic obstructive pulmonary disease; Coma; Consciousness; Consciousness Disorders - etiology; Delirium; Delirium - epidemiology; Emergency; Emergency medical care; Emergency Service, Hospital; Female; Heart attacks; Hospitalization - statistics & numerical data; Humans; Infection - complications; Infection - epidemiology; Infections; Intensive Care Units - utilization; Male; Mental disorders; Metabolism; Mortality; Nervous System Diseases - complications; Nervous System Diseases - epidemiology; Observational studies; Patients; Prospective Studies; Time Factors; Turkey - epidemiology
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2016.10.004

Abstract Objectives Altered mental status (AMS) is a challenging diagnosis in older patients and has a large range of etiologies. The aim of this study was to investigate the nature of such etiologies in order for physicians to be better aware of AMS backgrounds and hence improve outcomes and mortality rates. Methods This prospective observational study was conducted at four emergency departments (EDs). Patients aged 65 years and older who presented to the ED with acute AMS (≤1 week), with symptoms ranging from comas and combativeness, were eligible for inclusion in this study. The outcomes, etiologies, Richmond Agitation and Sedation Scale scores, and the presence of delirium were recorded. Results Among 822 older patients with AMS, infection (39.5%) and neurological diseases (36.5%) were the most common etiologies. The hospital admission and mortality rates were 73.7% (n = 606) and 24.7% (n = 203), respectively. The mortality rate rose if AMS persisted for more than 3 days. Delirium was observed in 55.7% of the patients; these individuals had higher durations of AMS than those without delirium (median 24 h, interquartile range [IQR] 3–48 h; median 6 h, IQR 3–48 h, respectively; P = .010). Notably, delirium was observed in more than two-thirds of neurological patients. Conclusions The most common causes of AMS were infection and neurological diseases. Delirium was associated with AMS in nearly half the patients. Moreover, the rates of hospitalization and mortality remained high.